COLUiiBiA  mnVtP. SIT Y 
COLLEGE    OF  PKYST'T— 3 
-^ND   SUTRGFONS- 

7^:'-^a   OF  A   GOIvi:iTTEl 
OF  THE  MEDICAL  FACULTY 


J%5AA^\^^ 


n:^ 


Columbia  (Hnttimitp 

CoUege  of  ^^psiicians!  anti  ^urgeonsf 
Hibrarp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/reportofcommittOOcolu 


REPORT  OF  A  COMMITTEE  OF  THE 


MEDICAL  FACULTY 

IN 

COLUMBIA  UNIVERSITY 

Appointed  to  Study  the  Ways  and 
Means  of  Improving  Medical  Edu- 
cation with  Special  Reference  to  the 
College  of  Physicians  and  Surgeons 


SECTION  I. 


REPORT  OF  A  COMMITTEE  OF  THE  MEDICAL  FACULTY 
IN  COLUMBIA  UNIVERSITY  APPOINTED  TO  STUDY 
THE  WAYS  AND  MEANS  OF  IMPROVING  MEDICAL 
EDUCATION  WITH  SPECIAL  REFERENCE  TO  THE 
COLLEGE  OF  PHYSICIANS  AND  SURGEONS. 


SECTION  1. 


PURPOSES    AND    PERSONNEL    OF   THE    COMMITTEE 

This  Committee  was  appointed  by  the  Dean  of  the  Medical  School  to  study- 
medical  education,  particularly  that  in  vogue  in  the  College  of  Physicians  and 
Surgeons.  It  proposed  to  make  a  critical  review  of  the  present  courses  of  instruc- 
tion including  their  subject  matter,  correlation  and  methods  of  teaching.  As  a 
result  of  this  survey  it  was  hoped  that  certain  suggestions  might  be  offered  for 
improving  the  entire  medical  course  of  study  by  a  revision  of  the  present  schedule 
and  methods   for  the  benefit  of  the  students. 

The  Committee  was  appointed  in  October,  1920,  by  Dean  Darrach.  It  com- 
prised Dr.  William  Darrach,  chairman,  Dr.  James  Alexander  Miller,  Dr.  Albert 
Lamb,  Dr.  .J.  W.  Jobling,  Dr.  Sidney  R.  Burnap  and  Dr.  Frederick  Tilney,  sec- 
retary. The  meetings  of  the  Committee  were  held  bi-monthly,  often  in  consultation 
with  Professor  W.  H.  Kilpatpck,  Professor  of  the  Philosophy  of  Education  in 
Teachers   College  of   Columbia  University. 

In  accepting  this  invitation  to  consult  with  the  Committee,  Professor  Kilpatrick 
has  made  himself  responsible  for  the  soundness  of  those  educational  fundamentals 
which  the  Committee,  under  his  advice,  accepted  as  a  basis  for  their  critical  survejj. 
of  existing  practices  in  medical  education.  To  his  direction  must  be  credited 
the  adoption  by  the  Committee  of  certain  psychological  laws  upon  which  they 
hope  to  base  their  recommendations  for  changes  in  the  matter  and  method  of  teach- 
ing. For  his  careful  consideration  of  their  aims,  for  his  courteous  cooperation  in 
their  efforts  and,  above  all,  for  his  instruction  and  guidance  in  the  matter  of 
educational  principles  the  Committee  owes  to  Professor  Kilpatrick  a  debt  which 
cannot  be  overestimated. 


TRENDS  IN  AMERICAN  MEDICAL  EDUCATION-HISTORICAL  NOTE 

NOTE 

In  reviewing  the  history  of  medical  education  in  America,  the  Committee  was 
impressed  by  the  fact  that  apparently  little  sustained  consecutive  deliberation  had 
been  devoted  to  this  important  .matter.  Although  medical  education  in  this  country 
seems  to  be  instinctively  striving  in  the  right  direction,  it  has  been  and  still  is 
handicapped  by  many  difficulties.  It  has  been  embarrassed  by  the  dearth  and  im- 
proper organization  of  clinical  facilities;  it  has  been  encumbered  by  archaic  doc- 
trines of  education;  it  has  been  retarded  by  a  lack  of  the  thought  and  study  which 
its  best  interest  obviously  demands. 

A  brief  glance  at  the  development  of  medical  education  in  America  will  illustrate 


this  point.  For  convenience  of  discussion  three  more  or  less  distinct  historical 
periods  may  be  recognized;  namely,  the  Preceptorial  Period,  the  Didactic  Period 
and  the  Curriculum  Period. 

In  the  Preceptorial  Period  there  were  five  medical  schools  in  the  country,  con- 
nected with  universities,  in  which  short  courses  of  lectures  were  given.  The  medical 
student  had,  however,  in  addition  to  this  inadequate  instruction,  the  opportunity 
of  being  connected  with  a  practitioner  of  medicine  who  officiated  as  his  preceptor. 
The  student  thus  gained  a  considerable  contact  with  the  details  of  medical  practice 
and  acquired  much  valuable  clinical  experience. 

In  the  early  part  of  the  nineteenth  century  the  preceptorial  custom  was  dis- 
continued due  to  the  stress  of  competition.  Many  inferior  medical  schools  then 
came  into  existence,  maintaining  a  low  standard,  of  instruction  and  giving  students 
little  more  than  the  nominal  course  of  lectures  then  requisite  to  the  degree  of 
medicine. 

Although  the  early  preceptorial  system  offered  opportunity  to  study  clinical 
medicine  by  the  case  method,  this  study  was  at  best  but  fragmentary  and  not  in- 
telligently calculated  to  present  the  student  with  a  real  basis  of  medical  philosophy. 
In  the  Didactic  Period  even  this  feeble  effort  to  introduce  the  student  directly 
to  the  subject  material  of  his  study  seems  to  have  failed.  Instruction  depended 
upon  a  more  extensive  course  of  lectures  which  were,  however,  largely  theoretical 
even  in  the  clinical  branches.  The  majority  of  the  schools  of  that  period  had  few 
clinical  facilities,  and  hospital  work  was  accessible  only  to  those  who  obtained 
positions  as  internes  or  externes.  Pri\'ate  preceptors  and  quiz  masters  were  em- 
ployed by  students  who  could  afford  it  during  their  medical  courses.  Even  under 
these  circumstances  the  student  was  compelled  to  learn,  more  or  less  by  rote,  the 
books  on  medicine  rather  than  medicine  itself  in  the  living  subject.  In  some 
instances  this  didacticism  took  a  more  brilliant  turn  and  brought  the  student  at 
least  into  sight  of  his  living  material  through  the  so-called  clinical  lecture.  But  on 
the  whole  this  was  a  period  characterized  rather  by  the  exploitation  of  professorial 
personality  than  by  the  encouragement  of  teaching  efficiency. 

In  the  present  Curriculum  Period,  although  much  thought  has  been  given  to 
medical  education,  it  has  been  largely  confined  to  lengthening  the  course,  rearrang- 
ing the  studies,  raising  entrance  requirements  and  complying  with  certain  regula- 
tions imposed  by  the  State  Boards.  Thus  what  was  deemed  a  real  reform  in 
medical  education  was  made  by  Charles  Eliot  in  1871,  when  he  raised  the  entrance 
requirements  for  the  medical  school  of  Harvard  University  and  lengthened  the  cur- 
riculum to  three  years.  This  change  also  occasioned  a  rearrangement  of  courses 
in  such  a  way  as  to  provide  facilities  for  clinical  and  laboratory  instruction.  In 
1880  the  three  years'  course  of  nine  months  each  in  Harvard  was  extended  to  four 
years.  Other  institutions  of  the  country  followed  this  example,  and  it  is  now  a 
nation-wide  regulation  that  the  medical  course  in  all  recognized  schools  shall 
consist  of   four  years  of  at  least  eight  months  each. 

Although  considerable  attention  has  been  given  to  the  course  of  medical  educa- 
tion by  the  universities,  independent  medical  schools,  the  Association  of  American 
Medical  Colleges  and  the  Council  of  the  American  Medical  Association,  the  net 
result  of  these  deliberations  to  date  has  been  mainly  a  rearrangement  of  the  curri- 
culum with  special  emphasis  on  the  apportioning  of  time  to  the  different  departments 
and  courses.  Moreover,  certain  regulations  were  established  which  were  desirable 
and  necessary  to  meet  the  conditions  existing  several  years  ago.  But  these  regula- 
tions are  now  recognized— as  was  shown  at  the  meeting  of  the  Association  of 
Medical  Colleges  in  Chicago  in  1931— as  a  handicap  to  the  free  development  of 
individual  schools  to  meet  their  special  problems. 

There  'has  been  a  great  deal  of  curriculum  tinkering  with  little  constructive 
thought  given  either  to  the  subject  matter  of  the  courses  or  the  methods  of  in- 
struction. 

One  notable  exception,  however,  should  be  mentioned  in  this  connection ;  namely, 


the  effort  to  establish  a  real  contact  between  the  students  and  clinical  material  as 
conceived  and  administered  in  the  so-called  clinical  clerkships  of  the  fourth  year, 
and  in  the  third  year  dispensary  courses  in  medical  and  surgical  diagnosis.  Aside 
from  these  worthy  innovations,  the  departmental  courses  throughout  the  four  years 
still  lack  coordination,  and  correlation  between  the  courses  in  different  departments 
has  not  been  secured.  No  definite  arrangement  has  yet  been  made  to  allocate  topics, 
or  parts  of  topics,  among  the  departments.  Each  chooses  for  itself  with  consequent 
confusion  and  overlapping  as  the  result.  In  addition  to  this  is  the  regrettable  fact 
that  the  first  two  years  of  medicine,  as  taught  at  present,  are  practically  devoid  of 
any  direct  clinical  pertinence  and  may  justly  be  counted  as  two  years  of  science — 
two  long  years  of  study  that  afford  the  student  no  opportunity  for  satisfying  his 
desire  to  apply  the  knowledge  gained 

The  best  that  can  be  said  of  all  the  curriculum  tinkering  of  the  past  twenty 
years  is  that  it  has  devised  a  chronological  system  by  means  of  which  to  fill  the 
student's  time  completely.  From  the  educational  standpoint  this  is  mistaken  in  its 
intention  and  unsatisfactory  in  its  results.  It  does  not  take  into  account  the  stu- 
dent's keen  desire  to  apply  his  acquired  knowledge  at  the  earliest  possible  moment. 
It  gives  too  much  attention  to  the  convenience  of  institutional  schedules  and  not 
enough  to  the  opportunities  for  learning. 

Now,  to  secure  the  best  results,  the  method  of  teaching  medicine  or  any  other 
applied  science  must  be  formulated  in  agreement  with  certain  principles  which 
facilitate  the  process  of  learning,  before  the  required  topics  are  allocated  and  the 
available  time  is  apportioned  to  each.  And,  because  the  acquisition  of  knowledge  is 
an  indiviidual  attainment  based  upon  the  function  of  learning,  educational  miethods 
must  be  developed  according  to  the  laws  of  learning. 

The  first  essential  in  successful  teaching,  then,  is  the  recognition  of  these 
so-called  "Laws  of  Learning."  They  embody  a  statement  of  the  psychological 
conditions  most  favorable  for  the  acquisition  of  knowledge.  And  it  must  be  under- 
stood that  these  laws  have  been  formulated  from  the  experience  of  teachers  who 
have  made  it  their  business  to  study  the  conditions  under  which  knowledge  is  most 
readily  and  satisfactorily  acquired  and  most  effectively  retained.  These  laws  the 
Committee  deems  of  such  importance  that  it  has  included  a  brief  summary  of  them 
in  the  following  paragraphs : 


THE    LAWS    OF    LEARNING 

1.  The  Law  of  Readiness.  This  law  states  that  the  process  of  learning  is 
facilitated  if  the  neural  associations  are  ready  for  it  in  advance ;  i.  e.,  if  the  receiv- 
ing mechanism  is  prepared  or  set  for  the  specific  subject  or  situation.  This  readiness 
depends  not  only  upon  the  desire  to  learn  but  also  upon  the  pertinence  of  such 
learning  to  a  definite  goal  toward  which  the  desire  is  directed.  For  example,  when 
we,  ourselves,  desire  to  learn  about  a  specific  topic,  one  method  is  to  search  the 
literature.  What  we  read  may  make  no  impression  until  we  meet  some  statement 
pertinent  to  our  special  problem.  This  statement  then  immediately  fixes  our  atten- 
tion. It  is  grasped  and  retained.  Our  receiving  mechanism  was  prepared  or  set 
for  that   specific  information. 

Failure  to  appreciate  this  law  is  seen  when  we  require  the  beginning  medical 
situdent  to  learn  by  rote  the  description  of  a  bone  apparently  quite  unrelated  to  his 
existing  desire  to  know  how  to  treat  a  fracture.  His  neural  associations  are  ready 
and  set  for  the  study  of  miedicine  and  should  be  taken  into  account.  His  readiness 
is  based  upon  the  desire  to  understand  the  nature  of  disease  and  injury  so  that  he 
may  treat  them.  This  incentive,  already  existing,  stimulates  his  interest  and  holds 
his  attention,  provided  he  is  convinced  that  the  topic  under  discussion  is  pertinent 
to  his  desire.  If,  on  the  other  hand,  he  is  not  permitted  from  the  first  to  keep  his 
goal   in   sight,  the  pertinence   of  his   learning  loses  direction,   vital  linterest   in  the 


subject  flag's,  and  the  desire  to  learn  is  displaced  by  such  motives  as  mere  personal 
ambition  or  satisfaction  in  the  mastery  of  difficult  tasks.  These  motives  are  irrele- 
vant to  his  object.  They  are  more  calculated  to  develop  control  of  conduct  than 
to  stimulate  achievements  in  learning. 

In  order,  therefare,  to  maintain  the  favorable  set  or  readiness  which  facilitates 
learning,  it  is  necessary  to  keep  the  student  conscious  of  the  goal  which  he  seeks), 
and  to  convince  him  of  the  pertinence  of  his  efforts  to  reach  this  goal. 

2.  The  Law  of  Effect.  This  law  recognizes  that  the  neural  bonds  of  learning 
are  strengthened  if  the  mental  process  produces  a  sense  of  satisfaction.  The 
strengthening  of  these  bonds  facilitates  learning.  If,  for  example,  a  medical  student 
performs  an  experiment  which  is  technically  perfect  and  completely  satisfactory, 
his  neural  bonds  of  learning  from  this  experiment  are  strengthened;  that  is,  they 
are  much  more  likely  to  retain  and  make  adequate  appropriation  of  the  associations 
arising  from  the  experiment,  than  if  the  latter  had  proved  to  be  a  failure.  Satis- 
faction of  this  kind  varies ;  its  maximum  degree  is  attained,  according  to  the  Law 
of  Readiness,  only  when  the  knowledge  acquired  has  a  direct  and  pertinent  bearing 
upon  the  subject  for  which  the  student  is  set  or  ready.  If  the  student  understands 
that  the  experiment  he  has  just  performed  will  be  of  direct  service  to  him  in  medi- 
cine, his  effort  in  learning  will  be  attended  by  a  satisfaction  approaching  the  maxi- 
mum. On  the  other  hand,  if  the  efforts  to  learn  are  accompanied  by  a  sense  of 
annoyance,  the  neural  bonds  are  weakened.  Thus,  if  the  student  is  provided  with 
defective  instruments  and  inferior  material  as  factors  in  a  given  experiment; 
if  his  results  are  inconclusive  or  the  entire  procedure  appears  to  have  no  pertinent 
bearing  upon  medicine,  his  reaction  to  the  situation  is  one  of  dissatisfaction  and 
the  facility  in   learning   is  reduced  in  proportion. 

The  Law  of  Effect  in  learning,  therefore,  emphasises  the  necessity  of  maintain- 
ing a  reaction  of  satisfaction  in  the  student  toward  his  work.  It  indicates  that 
satisfaction  in  learning  depends  in  great  measure  upon  the  effectiveness  with  zvhich 
the  teacher  provides  the  student  with  the  proper  opportunities  to  learn. 

3.  The  Law  of  Exercise.  This  law  recognizes  the  fact  tliat  the  neural  con- 
nections are  strengthened  by  proper  repetition  at  sufficiently  short  intervals.  It 
also  recognizes  that  improper  repetition  may  weaken  these  bonds,  particularly  if 
the  repetition  be  in  opposition  to  the  Law  of  Effect  and  produce  a  sense  of  annoy- 
ance. Other  things  being  equal,  it  is  fair  to  presume  that  repetition  cannot  fail 
to  increase  learning,  and  the  more  frequent  the  contact  which  the  student  has 
with  the  same  or  closely  allied  situations  and  conditions,  the  more  effectively  is 
the  opportunity  for  learning  put  at  his  disposal.  Repetition,  to  be  effective,  must 
not  only  be  adequate  and  proper ;  it  must  have  due  regard  for  the  pertinence  and 
relaive  importance  of  the  'subjects  presented.  It  may  therefore  be  employed  with 
advantage  by  different  departments  whose  subjects  have  overlapping  boundaries. 
For  example,  in  the  study  of  the  heart,  the  morphology  of  this  organ  may  be  taken 
up  simultaneously  with  its  physiology,  thus  giving  much  pertinent  repetition  in 
these  two  closely  allied  aspects  of  the  study.  It  is  possible  that  other  departments 
might  enter  into  such  a  cooperation  and  contribute  still  further  to  the  illumination 
of  the  subject.  In  the  application  of  the  Law  of  Exercise  to  medical  education,  it  is 
evident  that  this  purpose  to  coordinate  courses  and  provide  a  variety  of  repetition 
from  several  different  points  of  approach  is  of  the   highest  importance. 


EXTENT  TO  WHICH  LAV/S  OF  LEARNING  HAVE  BEEN  HITHERTO 
APPLIED  IN  MEDICAL  EDUCATION 

With  the  laws  of  learning  in_  mind,  we  may  properly  ask  ourselves  whether 
we  have  employed  them  as  our  guides.  We  may  go  even  farther  and  inquire — 
has  the  medical  course  taken  cognizance  of  these  laws  at  all?  Considering  first  the 
Law  of  Readiness,   it  would  appear  that  we  have  disregarded  it  almost   entirely. 


The  medical  student  who  enters  upon  his  course  in  response  to  a  desire  to  be  of 
service  to  those  who  suffer  from  disease  or  injury,  comes  with  his  mind  preadjusted 
to  attain  a  definite  goal,  namely  the  understanding  and  proficiency  necessary  for  the 
care  of  the  sick.  For  the  first  two  years  his  efforts  are  limited  to  the  details 
of  certain  fundamental  scientific  subjects  which  are  treated  as  pure  sciences  shut 
off  from  contact  with  clinical  material.  The  student  wonders  why  he  is  so  long 
restrained  from  gaining  actual  experience  in  the  subject  upon  which  his  mind 
is  set.  He  often  asks  why  his  efforts  are  confined  to  anatomy,  physiology  and 
chemistry  during  his  first  year  when  he  desires  to  learn  about  disease.  How 
much  can  he  learn  about  disease  through  the  microscope  when  he  never  sees  a 
patient?  He  wants  first-hand  knowledge  and  he  wants  to  learn  it  under  con- 
ditions in  whidh  he  expects  to  use  it.  He  is  reluctant  to  accept  the  assurance  of 
his  instructors  that  all  this  preliminary  work  is  sanctioned  by  tradition  as  part  of 
his  mental  training.  He  may  reply  that  he  seeks  medical  as  well  as  mental  train- 
ing and  such  a  point  is  certainly  well  taken.  It  is  supported  by  the  opinion  of  the 
European  Medical  Commission  which  investigated  medical  education  in  the  United 
States,  last  year,  as  guests  of  the  National  Board  of  Medical  Examiners.  They 
recognized  the  fallacy  in  divorcing,  so  completely  as  we  have,  the  study  of  scientific 
principles  from  their  practical  application. 

We  ourselves  recognize  that  the  present  arrangement  of  the  curriculum  is  not 
in  harmony  with  the  first  Law  of  Learning  (Law  of  Readiness).  By  neglecting 
to  take  into  the  account  the  desire  of  the  student  for  direct  contact  with  the 
patient,  the  course  imposes  a  discouraging  handicap  and  affords  a  poor  method  of 
approach. 

How  little  we  apply  the  second  Law  of  Learning  (Law  of  Effect)  may  be 
appreciated  by  the  number  of  students'  complaints  each  year  concerning  the  course 
of  instruction.  These  complaints  are  by  no  means  all  of  them  captious  or  mere 
fault-^finding.  -  The  majority  of  them  do  not  represent  a  recognized  tendency 
among  students  towards  a  defensive  reaction  against  their  instructors.  There  is 
justice  and  validity  in  many  of  the  objections.  In  substance  the  complaints  con- 
cern nearly  every  department  to  some  extent.  They  embody  objections  to  the 
methods  of  instruction  because  they  are  inadequate  or  insufficient ;  to  the  dis- 
proportion in  the  amount  of  instruction  given  in  the  different  departments,  and 
they  especially  emphasize  the  scarcity  of  opportunities  for  the  study  of  clinical 
material.  There  are  also  objections  to  the  disposition  of  the  students'  time  much 
of  which  is  wasted  in  what  seems  to  be  unnecessary  transportation  from  one  in- 
stitution to  another ;  and  to  the  overcrowded  schedule  Which  gives  too  little  free 
time  for  collateral  reading.  All  of  these  objections  illustrate  dissatisfaction  and 
annoyance  which  are  in  direct  violation  of  this  Law  of  Effect. 

A  number  of  examples  might  be  cited  to  show  that  we  have  given  little  atten- 
tion to  the  Law  of  Exercise,  especially  as  it  bears  upon  the  possibilities  of  inter- 
departmental cooperation. — e.g.  During  a  certain  period  of  the  third  year  course  the 
subject  of  the  endocrines  was  so  stressed,  by  all  departments,  as  to  give  rise  to 
dissatisfaction  among  the  students  which  resulted  in  open  criticism  of  this  form 
of  repetition.  This  lack  of  coordination  needs  no  further  comment.  It  demonstrates 
to  what  degree  of  tedium  and  annoyance  the  student's  endeavor  to  learn  may  be 
subjected. 


WHAT  MEANS  MAY  BE  EMPLOYED   TO  BRING  MEDICAL  EDU- 
CATION IN  CLOSER  HARMONY  WITH  THE 
LAWS   OF  LEARNING 

The  need  of  improvement  in  our  medical  course  is  evident  to  the  teaching 
staff  of  the  College  of  Physicians  and  Surgeons,  and  is  recognized  by  medical 
teachers  in  other  institutions.  Steps  in  this  direction  should  be  taken-  as  soon  as 


possible,  and  especial  efforts  should  be  made  to  avoid  the  unprofitable  expedients 
of  the  past  which  have  been  confined  to  curriculum  readjustments.  Such  rearrange- 
ments are  of  relatively  little  importance  unless  the  principles  of  learning  are  made 
a  fundamental  basis  of  revision  in  medical  education. 

Much  may  be  done  in  the  way  of  improvement,  provided  all  of  the  instructors 
active  in  the  different  departments  will  give  the  subject  careful  thought,  keeping 
in  mind  the  main  theme,  namely,  the  construction  of  a  course  in  medicine  which  will 
provide  the  student  with  the  most  favorable  opportunities  for  learning. 

It  is  apparent  at  once  that  the  defect  caused  by  deferring  contact  with  clinical 
material  until  the  third  year  indicates  a  failure  to  recognize  th^t  medicine  is  an 
applied  science.  This  defect  may  be  easily  overcome  by  the  early  introduction  of 
the  student  to  clinical  material,  by  permitting  him  to  see  the  pertinence  of  his 
studies  during  the  first  and  second  years  in  their  direct  bearing  upon  injury  and 
disease.  There  can  be  no  doubt  that  the  most  effective  medical  text  and  the  best 
medical  teacher  is  the  patient.  The  courses  in  the  first  and  second  years  need 
such  rearrangements  as  to  permit  the  introduction  of  illustrative  material  of  this 
kind.  A  detailed  plan  for  such  rearrangement  has  already  been  devised  and  will 
soon  be  submitted  to  the  medical  teachers  of  the  school  under  Sections  IV  and  V 
of  this  report. 

Much  improvement  may  be  provided  in  methods  of  instruction.  The  medical 
student  desires  and  needs  to  learn  medicine.  Our  methods  of  teaching  should 
aim  primarily  to  meet  these  desires  and  needs.  In  selecting  the  most  effective 
methods  the  critical  distinction  between  information  and  knowledge  must  be 
recognized.  It  is  possible  to  impart  much  useful  information  concerning  disease 
and  injury  through  didactic  exercises  and  text  books,  but  actual  knowledge  of 
these  subjects  may  be  acquired  only  by  contact  with  patients  and  clinical  material. 
The  desirable  method  of  teaching  would,  therefore,  aim  to  combine  adequate 
clinical  opportunities  for  learning  with  the  proper  amount  of  didactic  instruction. 
It  is  desirable  that  this  method  be  so  applied  as  to  draw  a  sharp  distinction  in  the 
student's  mind  between  what  is  knowledge  and  what  is  information,  between  what 
he  knows  for  himself  and  what  he  has  either  heard  or  read  concerning  the  facts. 
The  course  of  education  which  fails  to  make  this  distinction  fails  to  give  the  student 
a  critical  insight  concerning  the  relatve  values  of  his  intellectual  possessions. 

The  coordination  of  the  courses  in  the  several  departments  to  provide  the 
most  ample  opportunity  for  learning,  is  another  problem  requiring  earnest  delibera- 
tion and  wise  selection. 


A    BRIEF    OF    THE    ESSENTIALS    FOR    SUCCESSFUL    TEACHING 

IN  MEDICINE 

First  Law  of  Learning 

1.  There  exists  in  the  student's  mind  a  desire  to  understand  disease  and 
injury  in  order  to  be  able  to  treat  it. 

2.  There  should  constantly  exist  in  the  instructor's  mind  a  recognition  of  this 
desire  of  the  student. 

Application  of  First  Law 

3.  The  relation  of  the  topic  presented — ^not  only  to  disease  or  injury  but 
also  to  the  desired  ability  to  treat  the  disease  or  injury — ^must  never  be 
allowed  to  completely  disappear. 

Second  Law  of  Learning 

4.  There  should  be  a  reaction  of  satisfaction  in  the  student  toward  his  work. 

Application  of  Second  Law 

5.  Each  exercise  should  be  so  planned  that  the  student  will  feel  that  he  has 
gained  from  it  knowledge  which  is  pertinent  to  the  object  of  his  desire. 

Third  Law  of  Learning 

6.  Repetition  of  each  topic  should  be  provided  for  wherever  proper  and 
pertinent. 

Application  of  Third  Law 

7.  Repetition  should  be  arranged,  so  far  as  possible,  to  exhibit  the  natural 
connections  of  each  topic  with  other  similar  topics,  so  that  the  association  and 
repetition  may  facilitate  the  final  conscious  retention  of  the  related  facts. 


The  Committee,  in  this  introduction  of  its  report,  presents  what  it  feels  to  be 
the  fundamental  principles  necessary  to  the  critical  study  of  medical  education. 
It  especially  requests  that  every  teacher  in  the  medical  school  carefully  review 
this  protocol,  giving  the  matter  his  earnest  attention,  and  making  such  criticisms  or 
comments  as  seem  to  him  warranted. 

Further  details  of  the  work  of  the  Committee  will  be  issued  subsequently  under 
the  following  Sections : 

Section  II.  Schedule  and  method  of  teaching  for  the  Fourth  Year  and  the 
desirability  of  the  addition  of  a   Fifth  Medical  Year. 

Section  III.  Method  of  teaching,  schedule  and  content  of  courses  in  the  Third 
Year  necessary  to  preparation  for  the  Fourth  Year. 

Section  IV.  Method  of  instruction,  material,  content  of  courses  and  schedule 
in  the  Second  Year  necessary  to  preparation  for  the  Third  Year. 

Section  V.  Method  of  instruction,  material,  content  of  courses  and  schedule 
in  the  First  Year  necessary  to  preparation  for  the  Second  Year. 


COLUMBIA  UNIVERSITY 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing, 
as  provided  by  the  rules  of  the  Library  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

' 

C28{633)M50 

